Analysis of metastatic ovarian tumors from extragenital primary sites

AIMS AND BACKGROUND: The aim of this study was to evaluate patients with metastatic ovarian tumors from extragenital primary sites. METHODS: The medical records of 75 patients were reviewed retrospectively for age at diagnosis, presenting symptoms, preoperative tumor marker levels, preoperative diagnostic workup, operative technique, intraoperative evaluation, frozen-section and pathology results, laterality of metastasis, and primary tumor site. The specific impact of metastasis from colorectal and gastric primary sites on laterality, gross features and dimensions of ovarian mass, volume of ascites and tumor marker levels was investigated. RESULTS: Primary sites were stomach (37.3%), colorectal region (28%), lymphoma (12%), breast (6.7%), biliary system (2.7%), appendix (1.3%) and small intestine (1.3%). It was not possible to identify the primary tumor site in 8 (10.7%) patients. Bilateral metastasis was found in 86.4% patients; 42.7% of the metastatic ovarian tumors were Krukenberg tumors; 50.7% of the ovarian masses were solid. Frozen section was confirmed by postoperative pathological results in 98% of the patients. The mean preoperative serum levels of tumor markers were 298.7 U/mL, 178 U/mL and 113.3 U/mL for CA 125, CA 19-9 and CA 15-3, respectively. CA 125 levels were above 35 U/mL in 81.3% of the patients. The presence of ascites was more frequent in ovarian tumors originating from colorectal and gastric primaries. CONCLUSIONS: Surgery is essential for the diagnosis of the primary tumor and necessary for relief of symptoms. The identification of the primary site is required to plan adequate treatment.     

Combined therapy of teicoplanin and caffeic acid phenethyl ester (CAPE) in the treatment of experimental mediastinitis in the rat

Post-sternotomy mediastinitis affects 1-3% of patients undergoing cardiac surgery and is lethal in 10-47% of these patients. We investigated the effect of an antioxidant/anti-inflammatory agent, caffeic acid phenethyl ester (CAPE), in the attenuation of inflammatory response induced by methicillin-resistant Staphylococcus aureus (MRSA) infection in a rat experimental mediastinitis model. Rats, divided into six equal groups, received MRSA precolonized stainless steel wire pieces implanted into their mediastinal spaces. Control group and CAPE control group received saline and CAPE 10 micromol/kg.day(-1 )respectively, where Group A received a single dose of teicoplanin 24 mg/kg i.m. for the first day and then 12 mg/kg.day(-1) . Group B received teicoplanin as in Group A plus CAPE 10 micromol/kg. day(-1 )intra-peritoneally. Group C received teicoplanin 60 mg/kg i.m. for the first day and then 30 mg/kg.day(-1 )and Group D received teicoplanin as in Group C plus CAPE 10 micromol/kg.day(-1) . By the end of 14 days rats were sacrificed and serum malondialdehyde (MDA), myeloperoxidase (MPO), nitric oxide (NO), urea and creatinine levels were evaluated. Mediastinal organ tissues were collected for histopathological analysis. Infection rates in all the drug-treated groups were lower than the control groups ( P=0.002) but statistical significance was attained only between the groups A and D ( P=0.018). In connective tissues and the peribronchial area polymorphonuclear leukocytic (PNL) infiltration in the treatment groups, although becoming very close, did not reach statistical significance (P =0.053, P=0.075, respectively). PNL infiltration especially in the peribronchial tissues of the Group B animals was found to be significantly less than the Control and CAPE Control groups with P values of 0.013 and 0.010, respectively. MDA and MPO levels were significantly lower in the treatment groups ( P<0.001 and P<0.001 respectively). Levels of the degradation products of NO were lower in treatment groups compared to two control groups (P=0.003, P= 0.005). NO levels in Group D were lowest among all treatment groups ( P=0.001). It has been demonstrated that although bacterial colonization can be controlled in mediastinitis, the inflammatory response persists. The combination of an antioxidant / anti-inflammatory agent, CAPE, added to standard antibiotic therapy might be effective in the treatment of post-sternotomy mediastinitis due to MRSA.     

Depression and anxiety levels of the mothers of children and adolescents with left ventricular assist devices

Ozbaran B, Kose S, Yagdi T, Engin C, Erermis S, Yazici KU, Noyan A, Ozbaran M. Depression and anxiety levels of the mothers of children and adolescents with left ventricular assist devices. Abstract: VADs have been used to provide treatment for end‐stage heart failure. Parents may feel overwhelmed with the VAD regimes responsibility and be affected from this process beside children. In this study, we aimed to evaluate the depressive and anxiety symptoms of mothers of the first eight children equipped with a VAD in Turkey. The mothers of eight pediatric patients living with VADs were filled BDI and STAI at first month of VAD implantation (E.I) and secondly six months after their first evaluation (E.II). In E.I, the BDI mean score of mothers was 20.87, in E.II 14.37. STAI‐S mean score was 53.37 in E.I and 43.62 in E.II. The Wilcoxon nonparametric‐paired t‐test revealed significant difference between baseline and end‐point STAI‐S scores (Z: ?2.035; p: 0.042), and for BDI scores (Z, ?1.965; p, 0.049). Prolonged usage of VAD may increase distress in parents. Psychiatric evaluation and support of the primary caregiver is important for the well‐being of the pediatric patients.     

Evaluating Giant Hydatid Cysts: Factors Affecting Mortality and Morbidity

Objective: The aim of this study was to evaluate the prognostic factors affecting morbidity and mortality among patients who underwent surgery for giant pulmonary hydatid cysts in our center.Methods: Data from 283 patients who underwent surgery in our center for pulmonary hydatid cyst between 2008 and 2018 were retrospectively analyzed. Cysts 10 cm in diameter or larger were considered giant hydatid cysts.Results: There were 145 women (51.2%) and 138 men (48.8%). Giant cyst (≥10 cm) was present in 57 patients (20.1%), while the other 226 patients (79.9%) had cysts smaller than 10 cm. Operations were performed using videothoracoscopic approach in 68 patients (24%) and with thoracotomy in 215 patients (76%). Hydatid cysts were on the left side in 129 patients (45.6%), on the right side in 143 patients (50.5%), and bilateral in 11 patients (3.9%). Postoperative morbidity occurred in 29 patients (10.2%). Use of videothoracoscopic surgical approach did not affect morbidity. The mortality rate within the first 90 days was 0.35% (n = 1).Conclusion: Giant cysts are more common in the young age group than in older adults. Regardless of cyst size, surgery should be performed as soon as possible after diagnosis to avoid potential complications.     

Isolated medial cuneiform fractures: report of two cases and review of the literature

Although fractures of the midfoot are common, cuneiform fractures are rarely seen. These fractures are frequently associated with other fractures of the midfoot such as Lisfranc fracture-dislocations. However, isolated cuneiform fractures are extremely rare, with few cases reported in the relevant literature. Herein, the authors report 2 cases of isolated medial cuneiform fractures. One of the patients was treated with headless screw fixation due to displacement in fracture configuration, and the other was treated conservatively. Fractures were united without any complication in both patients. In this report, the authors discuss the mechanism of injury, diagnostic challenges, and treatment options of isolated medial cuneiform fractures.     

Single-Nucleotide Polymorphisms in IL23R-IL12RB2 (rs1495965) Are Highly Prevalent in Patients with Behcet’s Uveitis and Vary Between Populations

Purpose: To test the frequency of single-nucleotide polymorphisms in the IL-10, IL23R-IL12RB2 genes in patients with Behcet’s uveitis.

Methods: Blood samples were collected from 89 Israeli and Turkish patients, and from healthy control subjects of different origins. Genomic DNA was extracted from peripheral blood leukocytes and genotyped.

Results: The risk allele, A, in rs1800871, of IL-10 gene was highly prevalent in Behcet’s uveitis and healthy control samples alike; highest among the Turkish groups. Prevalence of G allele, in rs1495965, in the IL23R-IL12RB2 gene was high in Behcet’s uveitis patients, and among healthy Turkish and Israelis of Middle Eastern origin, while lower among the other Israeli control group (77.9%, 78.9%, 27.8%, respectively, P < 0.001).

Conclusion: Our findings highlight the differences between populations and may account for the increased prevalence of the disease among Turkish and Israelis of Middle Eastern origin. Further studies are required to map other healthy and affected populations.     

Direct Sub‐Micrometer‐Patterning of Conjugated Polymers and Polymer Light‐Emitting Devices by Electron Beam Lithography

The lateral pattering of polymer light emitting devices (PLEDs) on the micro‐ and even sub‐micrometer level is a challenging task. Being able to fabricate devices with sub‐micrometer active device dimensions will, however, open new possibilities for fundamental studies as well as enable improvements in device performance. Therefore, in this study an electron beam‐based patterning method for conjugated polymers is evaluated, where the structuring is achieved by deliberate degradation and alteration of the molecular structure accompanied by a change in the emission properties. We find that the typical feature size accomplished with this method is approx. 2 µm for the active line width in PLEDs, while the in‐depth investigation of the structures shows that the lateral resolution is found to be approx. 500 nm.

     

A permanent junctional reciprocating tachycardia with an atypically located accessory pathway successfully ablated from within the middle cardiac vein

Permanent form of junctional reciprocating tachycardia (PJRT) is an uncommon form of atrioventricular re-entrant tachycardia due to an accessory pathway characterized by slow and decremental retrograde conduction. The majority of accessory pathways in PJRT are localized in the posteroseptal zone. Despite the high success rate, failure may occur during endocardial radiofrequency catheter ablation due to epicardial insertion of the accessory pathway. We report a case of PJRT in a 25-year-old man in whom the accessory pathway was located epicardially in the posteroinferior region and ablated from within the middle cardiac vein by radiofrequency catheter ablation.     

Safety of gadodiamide mixed with a small quantity of iohexol in patients with impaired renal function undergoing coronary angiography

Gadolinium-based contrast agents can be used in diagnostic and interventional angiography, and are safe in recommended doses in patients with impaired renal function, but the image quality is usually unsatisfactory. The objective of the present study is to evaluate the safety of gadolinium mixed with a small quantity of iodine-based contrast agent and the image quality of this mixture in patients with renal insufficiency undergoing diagnostic coronary angiography. Forty-two patients with baseline creatinine level >1.5 mg/dl were randomized into gadolinium or iodine groups. In the gadolinium group gadodiamide was mixed with 1 : 3 iohexole and in the iodine group only this agent was used as contrast material. Peak creatinine levels 48–72 h after the procedure were measured. The primary end point was the development of contrast-induced nephropathy (CIN), defined as >25% increase of baseline creatinine levels, and the secondary end points were absolute and relative changes in baseline creatinine levels. Total contrast volumes used were not different between groups (57 ± 11 ml in gadolinium and 55 ± 10 ml in iodine; P = 0.68). Mean creatinine level did not increase significantly in the gadolinium group (from 1.9 ± 0.3 to 1.9 ± 0.4 mg/dl; P = 0.06), but did in the iodine group (from 2.0 ± 0.4 to 2.3 ± 0.5 mg/dl; P = 0.001). No patient had CIN in the gadolinium group whereas 5 (23%) patients had this phenomenon in the iodine group (P = 0.048). Contrast regimen was very well tolerated in the gadolinium group, with only transient headache in two patients. Gadodiamide mixed with a small quantity of iohexol is safe in patients with azotemia undergoing diagnostic coronary angiography. The image qualities obtained with this combination are also satisfactory in all of the cases. Further evaluation of the safety of this technique is warranted, especially in other types of diagnostic and interventional procedures in which a higher amount of contrast dye is needed.